MEDICARE: MR. ROBERT PROCTOR M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5329	MA

General Provider Information

NPI Number	:	1659574234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT PROCTOR M.ED.

Provider Business Mailing Address
First Line	:	383 FRANKLIN ST
Second Line	:
City	:	WRENTHAM
State	:	MA
Zip	:	02093-2405
Country	:	US
Telephone Number	:	508-333-8290
Fax Number	:

Provider Business Practice Location Address
First Line	:	383 FRANKLIN ST
Second Line	:
City	:	WRENTHAM
State	:	MA
Zip	:	02093-2405
Country	:	US
Telephone Number	:	508-333-8290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	07/08/2007

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